NHC Statement on the 2017 Notice of Benefit and Payment Parameters for Health Insurance Marketplace

Washington, DC (November 25, 2015) – An initial analysis by the National Health Council (NHC) of the 2017 proposed Notice of Benefit and Payment Parameters (NBPP) for the health insurance marketplace shows that the proposed regulation touches on a broad range of issues that are of concern to people with chronic diseases and disabilities and their family caregivers.

While this is a positive step, the details are lacking. The patient community still awaits specific direction from the Center for Medicare and Medicaid Services (CMS) that would advance many of these issues.

The NHC urges the agency to address plan designs that discriminate against people with chronic conditions, including creating mechanisms that would spread a patient’s total out-of-pocket costs (copayments, coinsurance, deductibles) over the course of a calendar year.

The NHC recognizes that the health care delivery system is very complex, and we applaud the significant improvements that have been made to the Affordable Care Act since its inception. While the 2017 proposed regulation would move the insurance marketplace in the right direction, we are still waiting for more concrete action to ensure that the exchanges respect and protect people with chronic conditions.

On several issues important to patients, the proposed regulation asks for stakeholder feedback or states that more clarity will be forthcoming. For example, on the issues of network adequacy the NBPP recognizes the fact that the breadth of provider networks is a concern to patients and lays out a framework to establish network adequacy standards; however, these standards will be contained in future rulemaking.

Standardization of health plans offered through the exchanges is a core issue the NHC has championed. The NBPP does not require insurers to have standardized plans, but does suggest that the federal marketplace website will attempt to make it easier for shoppers to compare plans. But again, details are forthcoming.

We are pleased to see that the administration is considering revising its prior thinking on patient assistance programs (PAP) that are offered by non-profit organizations. Many patient advocacy organizations offer premium and cost-sharing support to help people with chronic conditions afford their care. The administration previously discouraged these programs for marketplace beneficiaries and is now seeking comment in the NBPP on whether to permit PAPs. We encourage the administration to reverse its prior thinking and allow these programs.

Unfortunately, the proposed regulation does not appear to address discriminatory plan design in a meaningful way. We are encouraged to see that CMS is looking to more proactively examine plans and deny those that do not meet certain requirements, but we urge the agency to include non-discrimination as one of these criteria.

The NHC will continue to review this lengthy document with a focus on cost-sharing structures and other plan design elements, transparency standards, uniformity of plans, and continuity-of-care standards that are meaningful to patients.

The NHC will be submitting formal comments on the NBPP by the December 21 deadline. The comments will be posted on the NHC website.